Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe
Someone claimed that poor countries have a lower rate of depression than rich countries because of an underdeveloped health system and underdiagnosis. Weird then how this global survey giving everyone the same interview found that anxiety was highest in developed countries and lowest in low income countries
Over-Diagnosis and Over-Treatment of Depression Is Common in the U.S. - "Americans are over-diagnosed and over-treated for depression, according to a new study conducted at the Johns Hopkins Bloomberg School of Public Health. The study examines adults with clinician-identified depression and individuals who experienced major depressive episodes within a 12-month period. It found that when assessed for major depressive episodes using a structured interview, only 38.4 percent of adults with clinician-identified depression met the 12-month criteria for depression, despite the majority of participants being prescribed and using psychiatric medications."
Of course it cannot be the case at all that depression can be over diagnosed. It can only be under diagnosed
6 Facts About Mental Health in Brazil - "Among the Brazilian population, around 68% is between the ages of 15-64, a target age range for both anxiety disorders and depression. Brazil leads in the world in terms of anxiety cases and ranks fifth for cases of depression, while access to public health support for treatment remains low... People recognize mental health in Brazil as taboo"
Depression is only high in Brazil compared to other poor countries because mental health is well-funded there and depression is not stigmatised
How Western Psychology Needs To Rethink Depression - "Consider the role of employment — someone without a job is three times more likely to be depressed than someone working. As for education — those who didn't graduate from high school are 2.5 times more likely to be depressed than those with some college or greater... The take home lesson is that we have to understand context in order to understand depression. Jerome Kagan, a pioneer in the field of psychology, argued this point powerfully in a Radio Boston interview late last week. His new book, "Psychology's Ghosts," challenges psychology and psychiatry to approach their patients in a radically different way... Malaria means not that you have a fever but that you have the malarial parasite. Psychiatry is the only sub-discipline in medicine where the diagnoses are only based on the symptoms... "The best predictor today in Europe or North America of who will be depressed is not a gene and it’s not a measure of your brain — it’s whether you’re poor... "You know, we had a lot of trouble with Western mental health workers who came here immediately after the genocide, and we had to ask some of them to leave...They came and their practice did not involve being outside in the sun like what you’re describing – which is, after all, where you begin to feel better. There was no music or drumming to get your blood flowing again when you’re depressed and you’re low and you need to have your blood flowing. There was no sense that everyone had taken the day off so that the entire community could come together to try to lift you up and bring you back to joy. There was no acknowledgement of the depression as something invasive and external that could actually be cast out of you again. Instead, they would take people one at a time into these dingy little rooms and have them sit around for an hour or so and talk about bad things that had happened to them. We had to get them to leave the country.""
Do Antidepressants Really Work? - The New York Times - "The more popular antidepressants become, the more questions they raise. The drugs are one of the most widely prescribed types of medications in the United States, with more than one out of eight Americans over 18 having recently taken them, according to a survey from the Centers for Disease Control and Prevention. Yet we know very little about how well antidepressants work over the long term, and especially how they affect overall quality of life, experts say... A study published yesterday in the journal PLoS One aimed to close this knowledge gap by comparing, over the course of two years, the changes in quality of life reported by Americans with depression who took antidepressants versus the changes reported by those with the same diagnosis who did not take the medications... The paper found no significant differences in the changes in quality of life reported by the two groups, which suggests that antidepressant drugs may not improve long-term quality of life... “There’s just so much that’s not known,” said Robert DeRubeis, a psychologist at the University of Pennsylvania who studies the causes and treatments of mood disorders. “It’s not at all clear that even in the short term, pharmacological approaches, on average, are more effective than psychological ones,” he added. Clinical trials suggest that although antidepressants do improve depression symptoms over the first few months, their benefits are modest and are much less pronounced among people with mild depression compared with those with severe depression. (This is worrying considering that, according to one study, 73 percent of Americans prescribed antidepressants don’t even have a diagnosis of depression.) And experts are divided over whether these small benefits make a noticeable difference to people’s moods or overall functioning. Some doctors, for instance, have argued that the improvements people experience while taking antidepressants are not much larger than what they might experience taking sugar pills... Research suggests that people can also experience unpleasant withdrawal symptoms, known as antidepressant discontinuation syndrome, when they stop taking antidepressants, sometimes for weeks or months, and that the drugs can pose other risks, perhaps increasing the likelihood of strokes, heart attacks, falls and even death. And of course, like any medication, antidepressants can cause side effects, including nausea, agitation, weight gain, lower sex drive and indigestion."
Doctors have stopped thinking a 'chemical imbalance' causes depression - "Psychiatry has known for some time that the “serotonin theory” of depression, the notion that too little of the brain chemical can be a cause of depression, a decades-old hypothesis and deeply entrenched trope in society that helped promote a class of antidepressants taken by millions of Canadians, is wrong, says Montreal psychiatrist Dr. Joel Paris. “You want to know why it took so long for the truth to come out,” Paris, a professor of psychiatry at McGill University, wrote in an email. “I am afraid this has something to do with the toxic relationship between industry and academia.” Drug companies encourage doctors to prescribe often, and heavily, he said, and have “paid many academic psychiatrists to promote their products.” Two months after a major review found no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations, no convincing evidence of a “chemical imbalance,” the paper is still stirring controversy. Its authors say they have been ridiculed and attacked and accused of dog whistling to far-right commentators who have groundlessly linked antidepressants to mass shootings... Some psychiatric opinion leaders dismissed the study as “old wine in new bottles,” arguing that no serious psychiatrist today believes depressions are due to a tidy, simple imbalance in brain chemicals or “serotonergic deficit.” Apparently no one told the public. One survey of Australian adults found 88 per cent believes the “chemical imbalance” hypothesis of depression... The serotonin theory seemed promising when first introduced 60 years ago, “but was soon discarded,” said Dr. Allen Frances, a professor emeritus of psychiatry at Duke University who led the task force that created the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders in 1994. The association was weak and often didn’t replicate. “Depressions are so remarkably heterogenous, there can’t possibly be any unitary cause,” Frances said. “Further study revealed just how ridiculously complicated is brain structure and function.” But the “chemical imbalance” theory was a marketing godsend for drug companies... We’ve allowed a “pathologizing” of our human condition, she said. “If I’m feeling happy and peaceful, that’s great, but anything else has become a symptom.” When high school kids talk about their emotions today, “they use language that medicalizes their thoughts and feelings,” she said. “It’s just my OCD,” obsessive compulsive disorder. “I was a shy kid. Kids in my class now in university, they’ve got social anxiety disorder.”... Paris, of McGill, agrees that SSRI’s are overused. “The old adage is that if you have a hammer, everything looks like a nail. Clinicians want to do something for their patient, and these days that will usually be a prescription, given that psychotherapy is so poorly insured in Canada.”"
Antidepressants No Better Than Placebo for About 85% of People - "Unfortunately, the researchers found no way to predict who, exactly, is in this 15%. They write that if everyone with a depression diagnosis is given an antidepressant, about seven people need to be given the drug (and thus be exposed to the harmful effects with no benefit) before one person benefits... Clinical trials also usually hand-pick their participants, searching for those with no other conditions and who are not suicidal. This makes them very different from the individuals most often treated with the drugs in real life. Indeed, in a study this year, other researchers found that response to treatment is much lower in real life... In another paper, those same researchers also found that those with more severe depression, those with comorbid anxiety, and those who were suicidal were least likely to benefit from the drugs."
Is everything you think you know about depression wrong? - "In the 1970s, a truth was accidentally discovered about depression – one that was quickly swept aside, because its implications were too inconvenient, and too explosive... If they followed [the DSM], they had to diagnose every grieving person who came to them as depressed and start giving them medical treatment. If you lose someone, it turns out that these symptoms will come to you automatically. So, the doctors wanted to know, are we supposed to start drugging all the bereaved people in America? The authors conferred, and they decided that there would be a special clause added to the list of symptoms of depression. None of this applies, they said, if you have lost somebody you love in the past year. In that situation, all these symptoms are natural, and not a disorder. It was called “the grief exception”, and it seemed to resolve the problem. Then, as the years and decades passed, doctors on the frontline started to come back with another question. All over the world, they were being encouraged to tell patients that depression is, in fact, just the result of a spontaneous chemical imbalance in your brain – it is produced by low serotonin, or a natural lack of some other chemical. It’s not caused by your life – it’s caused by your broken brain. Some of the doctors began to ask how this fitted with the grief exception. If you agree that the symptoms of depression are a logical and understandable response to one set of life circumstances – losing a loved one – might they not be an understandable response to other situations?... The grief exception seemed to have blasted a hole in the claim that the causes of depression are sealed away in your skull. It suggested that there are causes out here, in the world, and they needed to be investigated and solved there. This was a debate that mainstream psychiatry (with some exceptions) did not want to have. So, they responded in a simple way – by whittling away the grief exception. With each new edition of the manual they reduced the period of grief that you were allowed before being labelled mentally ill – down to a few months and then, finally, to nothing at all. Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away... this debate reveals a key problem with how we talk about depression, anxiety and other forms of suffering: we don’t, she said, “consider context”. We act like human distress can be assessed solely on a checklist that can be separated out from our lives, and labelled as brain diseases. If we started to take people’s actual lives into account when we treat depression and anxiety, Joanne explained, it would require “an entire system overhaul”. She told me that when “you have a person with extreme human distress, [we need to] stop treating the symptoms. The symptoms are a messenger of a deeper problem. Let’s get to the deeper problem.”... a few months into my drugging, something odd happened. The pain started to seep through again. Before long, I felt as bad as I had at the start. I went back to my doctor, and he told me that I was clearly on too low a dose. And so, 20 milligrams became 30 milligrams; the white pill became blue. I felt better for several months. And then the pain came back through once more. My dose kept being jacked up, until I was on 80mg, where it stayed for many years, with only a few short breaks. And still the pain broke back through... Why was I still depressed when I was doing everything I had been told to do? I had identified the low serotonin in my brain, and I was boosting my serotonin levels – yet I still felt awful... Why were so many other people across the western world feeling like me? Around one in five US adults are taking at least one drug for a psychiatric problem. In Britain, antidepressant prescriptions have doubled in a decade, to the point where now one in 11 of us drug ourselves to deal with these feelings. What has been causing depression and its twin, anxiety, to spiral in this way?... could it really be that in our separate heads, all of us had brain chemistries that were spontaneously malfunctioning at the same time?... there is evidence that seven specific factors in the way we are living today are causing depression and anxiety to rise – alongside two real biological factors (such as your genes) that can combine with these forces to make it worse... [drug companies] would fund huge numbers of studies, throw away all the ones that suggested the drugs had very limited effects, and then only release the ones that showed success. To give one example: in one trial, the drug was given to 245 patients, but the drug company published the results for only 27 of them. Those 27 patients happened to be the ones the drug seemed to work for... between 65 and 80% of people on antidepressants are depressed again within a year... How do we know depression is even caused by low serotonin at all?... the evidence was strikingly shaky. Professor Andrew Scull of Princeton, writing in the Lancet, explained that attributing depression to spontaneously low serotonin is “deeply misleading and unscientific”. Dr David Healy told me: “There was never any basis for it, ever. It was just marketing copy.”... Most of the depressed and anxious people I know, I realised, are in the 87% who don’t like their work... if you have no control over your work, you are far more likely to become stressed – and, crucially, depressed. Humans have an innate need to feel that what we are doing, day-to-day, is meaningful. When you are controlled, you can’t create meaning out of your work. Suddenly, the depression of many of my friends, even those in fancy jobs – who spend most of their waking hours feeling controlled and unappreciated – started to look not like a problem with their brains, but a problem with their environments... finding an antidepressant didn’t mean finding a way to change your brain chemistry. It meant finding a way to solve the problem that was causing the depression in the first place... In its official statement for World Health Day in 2017, the United Nations reviewed the best evidence and concluded that “the dominant biomedical narrative of depression” is based on “biased and selective use of research outcomes” that “must be abandoned”. We need to move from “focusing on ‘chemical imbalances’”, they said, to focusing more on “power imbalances”."
The "mental health" squad won't be happy, since they insist on medicalising and "destigmatising" depression and avoiding "victim blaming", which is why they get very upset when you suggest that depressed people get some exercise. Drugs and maybe therapy are the only acceptable treatments for depression!
Exercise is even more effective than counselling or medication for depression. But how much do you need? - "When comparing the size of the benefits of exercise to other common treatments for mental health conditions from previous systematic reviews, our findings suggest exercise is around 1.5 times more effective than either medication or cognitive behaviour therapy. Furthermore, exercise has additional benefits compared to medications, such as reduced cost, fewer side effects and offering bonus gains for physical health, such as healthier body weight, improved cardiovascular and bone health, and cognitive benefits. Exercise is cheaper than medication, with fewer side effects."
Some people got very upset when I posted this with the comment that exercise was better than anti-depressants (in response to a claim that before meds are tried, other factors should be considered) and sarcastically tagged "wow thanks i'm cured" or claimed that exercise didn't work for them (so the point was useless). Clearly if someone posts about how cigarette smoking increases the chance of lung cancer, lots of non smokers who got lung cancer need to savage him for being ignorant.
Depression treatment: 30 years after Prozac arrived, we still buy the lie that chemical imbalances cause depression - "depression isn’t caused by a chemical imbalance, we don’t know how Prozac works, and we don’t even know for sure if it’s an effective treatment for the majority of people with depression. One reason the theory of chemical imbalances won’t die is that it fits in with psychiatry’s attempt, over the past half century, to portray depression as a disease of the brain, instead of an illness of the mind. This narrative, which depicts depression as a biological condition that afflicts the material substance of the body, much like cancer, divorces depression from the self. It also casts aside the social factors that contribute to depression, such as isolation, poverty, or tragic events, as secondary concerns. Non-pharmaceutical treatments, such as therapy and exercise, often play second fiddle to drugs... though various people could be classed as suffering from a distinct depressive disorder according to their life events, there aren’t clearly defined treatments for each disorder. Patients from all groups are treated with the same drugs, though they are unlikely to be experiencing the same underlying biological condition, despite sharing some symptoms. Currently, a hugely heterogeneous group of people is prescribed the same antidepressants, adding to the difficulty of figuring out who responds best to which treatment... “[T]he serotonin hypothesis is typically presented as a collective scientific belief,” write Lacasse and Leo, though, as they note: “There is not a single peer-reviewed article that can be accurately cited to directly support claims of serotonin deficiency in any mental disorder, while there are many articles that present counterevidence.” Despite the lack of evidence, the theory has saturated society. In their 2007 paper, Lacasse and Leo point to dozens of articles in mainstream publications that refer to chemical imbalances as the unquestioned cause of depression... 30 years after Prozac was released, rates of depression are higher than ever. Hyman responds succinctly when I ask him to discuss the causes of depression: “No one has a clue,” he says. There’s not “an iota of direct evidence” for the theory that a chemical imbalance causes depression, Hyman adds. Early papers that put forward the chemical imbalance theory did so only tentatively, but, “the world quickly forgot their cautions,” he says. Depression, according to current studies, has an estimated heritability of around 37%, so genetics and biology certainly play a significant role. Brain activity corresponds with experiences of depression, just as it corresponds with all mental experiences. This, says Horwitz, “has been known for thousands of years.” Beyond that, knowledge is precarious. “Neuroscientists don’t have a good way of separating when brains are functioning normally or abnormally,” says Horwitz. If depression was a simple matter of adjusting serotonin levels, SSRIs should work immediately, rather than taking weeks to have an effect. Reducing serotonin levels in the brain should create a state of depression, when research has found that this isn’t the case. One drug, tianeptine (a non-SSRI sold under the brand names Stablon and Coaxil across Europe, South America, and Asia, though not the UK or US), has the opposite effect of most antidepressants and decreases levels of serotonin. This doesn’t mean that antidepressants that affect levels of serotonin definitively don’t work—it simply means that we don’t know if they’re affecting the root cause of depression. A drug’s effect on serotonin could be a relatively inconsequential side effect, rather than the crucial treatment. History is filled with treatments that work but fundamentally misunderstand the causes of the illness. In the 19th century, for example, miasma theory held that infectious diseases such as cholera were caused by noxious smells contributing “bad air.” To get rid of these smells, cleaning up waste became a priority—which was ultimately beneficial, but because waste feeds the microorganisms that actually transmit infectious disease, rather than because of the smells. It’s possible our current medical categorization and inaccurate cultural perception of “depression” is actually causing more and more people to suffer from depression. There are plenty of historical examples of mental health symptoms that shift alongside cultural expectations: Hysteria has declined as women’s agency has increased, for example, while symptoms of anorexia in Hong Kong changed as the region became more aware of western notions of the illness... psychiatry “reframes ordinary distress as mental illness”... there’s very little difference between antidepressants and placebos... while drugs and therapy are similarly effective in the short-term, in the long-term those who don’t take medication seem to do better and have a lower risk of relapse... “Some people really respond, some don’t respond at all, and everything in between,” Hyman adds. There are currently no known biomarkers to definitely show who will respond to what antidepressants... there’s evidence to suggest framing depression as a biological disease reduces agency, and makes people feel less capable of overcoming their symptoms. It effectively divorces depression from a sense of self... Some might worry that a mental health condition treated partly with therapy, exercise, and societal changes could be seen as less serious or less legitimate. Though this line of thinking reflects a well-meaning attempt to reduce stigma around mental health, it panders to faulty logic. After all, many bodily illnesses are massively affected by lifestyle. “It doesn’t make heart attacks less real that we want to do exercise and see a dietician”"
So much for anti-depressants being good because they give people a fighting chance
Internal Acceptance Movement - "I wear glasses. Can I manage without glasses? Well, yes, probably. I could squint a lot, constantly move up close to anything I want to see, take the bus or a taxi if I want to go anywhere. I could just accept that I’ll never be able to see eagles flying in the sky or whales jumping out of the ocean. But why? Why try so hard to manage life when I could just put on a pair of glasses? No one would ever suggest a near-sighted person should just work harder. No one would say ‘Maybe that’s just your normal’ to someone that needs glasses. They would say ‘Let’s go to the eye doctor and get you a prescription so you’re able to see again.’ You shouldn’t have to try so hard.
My doctor (paraphrased), when I expressed doubts about going back on an anti-depressant."
Didn't know glasses can make me gain weight, or give me blurred vision or anxiety. And how many opticians prescribe glasses to people who don't need them?
Are we talking ourselves into a mental-health crisis? - "Mental health is starting to lose all meaning and significance. In the trailer for The Me You Can’t See, starring Prince Harry, Oprah Winfrey states: ‘All over the world, people are in some kind of mental, psychological, emotional pain.’ Of course, this is partly true, if a little apocalyptic. Everyone at some point in their lives feels melancholic, worried, anxious, lonely or perhaps even depressed. But it is important to remember that these are perfectly normal human emotions. By turning these feelings into diagnosable conditions, we are beginning to perceive these feelings as something that can be easily solved through medical means. As Arthur Miller once stated: ‘Psychoanalysis is the preconception that suffering is a mistake, a sign of weakness or an illness.’... Our heightened sense of ‘awareness’ for mental health is also becoming a problem for free speech. Anyone who ventures on to social media will have seen the hashtag #BeKind. Of course, at times, it seems like some Twitter users need to be reminded that their words and actions lack common decency. But it also acts as an instruction for others to self-censor their opinions in case it may upset someone. In reality, ‘be kind’ is often code for ‘be quiet’. At the same time as discussion about mental-health issues can be found everywhere, there are lots of people, particularly those from disadvantaged backgrounds, who are suffering in silence and are unable to find support for genuine problems. So much attention is devoted to minor grievances that those with a serious need to access support are crowded out."
We need to stop making mental illness look cool on social media - "A quick search of #depressed on Instagram brings up over 12 million posts. Interspersed between black and white photos and gifs of crying cartoons are pictures of pretty girls smoking and the occasional sadboi-with-tattoo overlaid with text like "Help me" and "I want to go far away … forever." These romanticized depictions of mental illness are what mental health professional Aditi Verma calls “beautiful suffering”: a meme-ified version of mental illness that reduces anxiety and depression to a temporary feeling capable of being depicted through dark edits and simplified text. The trend appeared on Tumblr over a decade ago, but has spread to platforms like Instagram. Full accounts like @sadthoughts_1 and @__depressionquotes, which have thousands of followers, are dedicated solely to this type of content. With a 71 percent increase in mental illness diagnoses in adults aged 18-25 during the last 10 years, the trend of falsely portraying the mentally ill experience threatens the already fragile well-being of more young people than ever before... “My first thought after being told by my psychiatrist that I was experiencing bipolar symptoms was ‘Damn, this isn’t even one of the cool ones,’” Alex, a 20-year-old student, says. “I realized how weird that sounded, backed up, and realized [I said that] because I couldn’t remember a single time on Tumblr or wherever where bipolar was mentioned in any way that didn’t basically mean ‘crazy person’.” This trend of “beautiful suffering” innately splits mental illnesses into “cool” and “uncool,” creating a schism that pushes the mental illnesses deemed too taboo for aesthetic appropriation further into the abyss. This allows some to appear, by association, more like Lana Del Rey, whose image has always been based upon maintaining a level of physical beauty through a narrative of (but not limited to) abuse, suicidal ideation, and melancholy... These aesthetics imply that having one of the “cool” illnesses grants you intelligence, uniqueness, and glamour. The inverse implication is that owners of an “uncool” mental illness are not only lacking in these areas, but will continue to soak up whatever’s left of the transgressive “crazy” stereotype"
Commentary: When we call people with strange behaviour mentally ill, we reinforce mental health stigma - "several online commenters called these women “crazy”, “with a hole in the brain” and “confirm mentally ill”. The actions in the videos were problematic, but these comments left an even more bitter aftertaste. While some commenters explicitly mocked them, others seemed to have jumped the gun to assume these women had mental illness and urged others to understand. Either way, such assumptions seem to reinforce the dated stereotype that those with mental illness would necessarily behave in “crazy” ways, and cannot be taken seriously - a fundamental reason for the prevailing stigma around mental illness."
Weird how "crazy" is equated with "has a mental health condition"
There is a school of thought that criminality is evidence of a mental health condition too, so
Stress is normal, Prince Harry – and you don’t need an emotional support dog to handle it - "The most vulnerable (unsurprisingly perhaps) are aged 18–24. They deal with it by “doom scrolling”. So, no more learning about Ukraine or global warming, eh? The next age group (25-32) watches the telly too much – and if you’re approaching 40 you’ll eat too much. Those who suffer from “the scaries” are being urged by Health Secretary Thérèse Coffey to go online to put together a personalised “mind plan”... Prince Harry revealed only this week that their three pets are “emotional support” dogs. These days, you don’t even have to live in California to have one. People here in the UK can register a pet – whether it’s a dog or a ferret – with “a licensed mental health practitioner” who will attest to the psychological benefits of having it with you, whether it’s on a plane or in a restaurant to, err, soothe frayed nerves. Of course, there are millions who get enormous comfort from being with their pets. They might even call it “emotional support”. And no doubt there are people who will be offended by my somewhat sceptical approach to the “Sunday scaries” campaign. But, isn’t it also right to question whether the Government department responsible for the shocking state of the NHS has its priorities right? Ambulances that arrive too late. Nurses retiring in droves. GPs who are far too busy to see patients in the flesh. Cancer outcomes that would shame many other European countries. A care service that is on its knees. The list is very, very long. This generation’s obsession with “stress” is not helping. Should we not give a little more thought to the way we endlessly conflate “stress” with “mental health”?... We use the phrase “mental health” often without even being able to articulate what we mean by it. We expect young children to assess their own mental health. How can they? They’re children. But they are becoming conditioned to believe that to be unhappy for even a short time is to have mental health “issues”. It isn’t. It’s the human condition."
The therapyspeak people will be very upset and will say we cannot dismiss trauma and that those who disagree just show they're flawed and need to heal and become better people, and that mental health is very important
Kayley Govender🤪 on Twitter - "Yeah, Instagram is bad for our mental health but what about Outlook"
Any form of stress threatens "mental health"
